Beckert: Health care reform the Wisconsin way

Senate Majority Leader Mitch McConnell is giving lukewarm support to President Donald Trump's FY2018 budget proposal, telling reporters that lawmakers will "decide what to do with those recommendations." (May 23)
AP

President Donald Trump (left) stands with House Speaker Paul Ryan (R-Wis.) (right) and Freedom Caucus Chairman Mark Meadows (R-N.C.), after Republicans passed legislation aimed at repealing and replacing Obamacare during an event in the Rose Garden at the White House on May 4.(Photo: Getty Images)

Wisconsin has been a leader in covering its residents with high-quality health care and providing community supports so people with disabilities and frail elders can stay in their homes and communities and out of costly facilities. The American Health Care Act poses a particularly dangerous threat to our state’s residents, in part because we have done so much right.

One in five Wisconsinites use Medicaid and nearly a quarter-million get health care coverage under the Affordable Care Act. The ACA and Medicaid keep our children, older adults and people with disabilities healthy participants in their communities. The American Health Care Act will change that, dramatically decreasing health care coverage and Medicaid funding.

The bill passed by the House of Representatives would cut Medicaid by $880 billion or 25% over 10 years and enact a “per-capita cap”— converting Medicaid from an entitlement that covers any costs incurred and instead putting a cap on federal funds. The bill uses those savings to lower taxes for the wealthy while sacrificing supports for needy children and families, people with disabilities and seniors.

Our state is particularly at risk to lose, precisely because it has been a leader in developing innovative, cost-effective Medicaid programs that have enjoyed bipartisan support. Wisconsin stands to lose $13 billion in federal funding for Medicaid, CHIP and financial assistance for marketplace coverage — resulting in thousands losing coverage and access to services.

The House bill also does not offer an adequate path for covering the 2.5 million Wisconsinites with a pre-existing condition, allowing states to opt out of current requirements. Without ACA protections, they could be denied coverage, charged unaffordable prices for insurance and have annual and lifetime limits for coverage. If essential benefits aren’t required, insurance won’t be required to cover prescription drugs, hospitalization, outpatient services, mental health services, substance abuse disorder treatment, autism therapy and other “essentials." Significantly higher cost for less coverage is a bad deal for consumers.

The bill’s proposal to bring back high risk insurance pools is not the solution. Wisconsin’s high risk pool had the second-highest per-capita participation among 35 states. But it was too costly for most people: serving only 21,000 at a time when 500,000 Wisconsinites were uninsured. Putting everyone with high costs into one plan doesn’t work.

So let’s look at what is needed for real health care reform: a plan that will address our real cost drivers for health care. A report from The State Health Care Cost Containment Commission, identifies nine drivers of healthcare costs including:

Physician, facility and drug costs. Data from the Organization for Economic Cooperation and Development consistently show costs for U.S. physicians, hospitals, facilities and drugs are the highest in the world.

High administrative expenses. The morass of health insurers and billing processes costs the U.S. health care system billions in wasted costs every year.

Fragmented and uncoordinated care. Because care providers often treat the same patient with little consultation, unnecessary care, errors and dissatisfaction proliferates.

In addition, we need to retain what works in the current system, including Wisconsin’s Medicaid program, which saves money by reducing reliance on institutional and crisis care for our most vulnerable residents. Wisconsin draws down billions in federal Medicaid funding, enabling our limited state funds to go further and serve more people.

Our innovative cost-effective programs are national models that should be replicated, not cut:

Family Care and IRIS provide long-term supports for seniors and adults with physical or developmental disabilities, keeping them in their homes and out of expensive institutions.

Children’s Long-Term Support Waiver and the Katie Beckett Program support children with disabilities or complex medical needs, and help families keep their children at home.

Comprehensive Community Services supports recovery for children and adults with a mental illness or substance abuse disorder.

BadgerCare provides health care security for low-income children and adults;

SeniorCare helps seniors afford the medications they need to maintain their health.

Wisconsin has been a leader in providing access to health care and long-term supports, ending wait lists and keeping people out of costly facilities. Let’s act now to protect Medicaid, retain essential benefits and ensure affordable and comprehensive coverage for those with pre-existing conditions. It’s the Wisconsin Way.